Friday, July 15, 2016

Hyperthyroidism in pregnancy

Pregnancy
Drugs of choice
First trimester
Propylthiouracil (PTU)
- risk of using MMI (higher risk of birth defects) out-weighs the low risk of developing hepatotoxicity with PTU during this time period
Second & third trimesters
Methimazole (MMI)
- Used for remainder of pregnancy
- to reduce the risk of PTU-induced hepatitis
Carbimazole (CBZ)
- converted into methimazole in the body
- 1mg of carbimazole is approximately equivalent to 10 mg of propylthiouracil.
*can also continue on PTU, given hepatic function monitored every 4 weeks with thyroid function tests. (no prospective data show monitoring of liver function tests will be helpful in preventing hepatotoxicity)

** the antithyroid drug dose should probably be tapered if (thyroid stimulating hormone) TSH rises into the normal range
References
6. press.endocrine.org/doi/full/10.1210/jcem.86.6.7573

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